Obamacare: Questions answered about Affordable Care Act

With the launch of new health insurance exchanges just about two weeks away, many of the questions in this month’s mailbag focused less on the big picture and more on exactly how the law will operate for individuals.

We can’t answer every question we get. But here is a sampling of questions that were really popular, or that would apply to a lot of people.

One of those questions came from Melanie Wilson of Kittery, Maine. “I’m self-employed and my yearly income varies widely from year to year,” she writes. She wants to know if the subsidies available for health insurance premiums will be based on gross or net income. “Since I’m self-employed I have a lot of deductions, so my gross looks good but at the end of the year the net can be pretty minimal.”

The subsidies, which are available to those earning between 100 percent and 400 percent of the federal poverty level, are based on your modified adjusted gross income, or MAGI. That includes things like wages and interest, less deductions like tuition and alimony, and additional payroll taxes paid by the self-employed. You’ll be asked to estimate what your income will be for next year; if you’re wrong, you’ll have to reconcile with the IRS come tax time the following April.

Francis Sheridan of Anchorage, Alaska, is curious about young people who opt to pay the tax penalty rather than purchase health insurance, which is an option under the law. “My question to them is when some of you, which will happen, are seriously injured or incur other health care, who’s going to pay your health care bills?”

If you don’t have insurance, you’ll get a bill, just like now. If you can’t pay, the hospital or other health care provider will still try to collect from you, although there are some provisions of the law aimed at discouraging some of the most aggressive collection tactics that have been used in the past. If they don’t collect, the health care provider would have to eat the cost. That’s why hospitals were so anxious to have most people covered by insurance, so they could stop having to provide so much free care to people who couldn’t pay.

Go to the link for more questions and answers.

The Texas Medical Association also is answering questions about the health care law as the insurance marketplaces are set to open Oct. 1.

What exactly is this Marketplace, and why should I care?

The Affordable Care Act requires most individuals to have health insurance in 2014. So the law requires that so-called health insurance exchanges — now referred to as marketplaces — be established in every state as another avenue for individuals to purchase private health insurance on their own. Most people get insurance through their jobs. But if you don’t have that option, you can shop in the marketplace instead of buying directly from insurance companies. Or maybe you have a certain condition that in the past prevented you from getting health insurance because it was too expensive or simply hard to get. Now, you will have options in the marketplace.

Changes under the ACA also require all private health plans to provide a minimum package of “essential health benefits,” which include a basic set of services like physician visits, hospital and emergency care, preventive services like vaccines and screenings, and prescription drugs. So any health plan you purchase on the exchange must cover these services, and they cannot deny you coverage because of a preexisting condition.

Instead of having to search out health plans on your own, the marketplace is designed to be a one-stop shop where you can go online to check out your coverage options in one place, get easy-to-understand information, and compare plans before you make a decision. Kind of like Orbitz or Travelocity, but for health insurance instead of travel. You can also find out right then and there if you qualify for a tax break on your private insurance premiums — another feature of the health reform law — or for state programs like Medicaid or the Children’s Health Insurance Program.

The time to sign up for plans offered in the marketplace is approaching: Open enrollment is slated to begin Oct. 1 for coverage beginning Jan. 1, 2014. Unless you qualify for an exemption under the federal law, you must get insurance starting Jan. 1 or you could have to pay a fine.

Where can I get more questions answered?

Because Texas chose not to launch its own marketplace, the federal government will run the exchange here and serve as the main resource for information and enrollment.

Right now, you can visit Healthcare.gov and CuidadoDeSalud.gov. to find checklists, videos and other resources to get ready for open enrollment, although actual plans and price comparisons won’t be available until Oct. 1. That’s when you’ll actually apply, too, but you can get ready now. A toll-free call center is available to help answer questions 24/7 at 800-318-2596. There also will be people in your community known as navigators to help with the enrollment process beginning in October.

Blue Cross and Blue Shield of Texas also launched a campaign called Be Covered Texas to help Texans understand the federal health reform law and navigate the new insurance marketplace in Texas. Call 866-427-7492 Monday through Friday 8 a.m. to 5 p.m. or go to BeCoveredTexas.org.

If you have questions about insurance you already bought in Texas or receive through your employer, contact the Texas Department of Insurance at 800-578-4677 or www.tdi.texas.gov/index.html.

There is a lot of information out there that can be difficult to sort through. Here are a few resources we have found helpful on the insurance marketplace, what to expect, and how to sign up:

• Healthcare.gov is the federal government’s official website for consumer information on the marketplace and the health care law overall.

• Another federal resource with explanations; checklists; and official forms, applications, and language materials, for instance, is http://marketplace.cms.gov/.

• BeCoveredTexas.org is an English-Spanish website that BCBSTX set up to help Texans understand how the marketplace will work in this state and to get signed up. The site offers materials like printable fact sheets on the marketplace and the health reform law and checklists.